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Medicare and ?????

MetalneckMetalneck The Island of Misfit toysPosts: 1,778
edited 06/11/2012 - 9:02 AM in Health Insurance Issues
Medicare ????

When getting your Medicare .... are most of you having to purchase a supplement (medigap coverage) or is the disabled status leading to medicaid as a secondary??

Oh please do tell!!

Thanks in advance,




  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    I know that some of us SSD people have Medicare by now. What are you doing for a secondary??

    Gee I didn't think this was a tough question.

  • A name brand that touts covering so much, needless to say they forget to mention that every proceedure has a $100 co-pay, doctors office visits vary from $25-$45. The most common types of pain medicines have a larger co-pay.

    After looking around alot more, it seems that they all are very similar in price and coverage.

    And after all these co-pays, I'm about to hit the donut hole where the insurance doesn't cover anything on Rx's except for a small discount on drugs, oh joy. So the next $2000 is out of pocket, after that I don't have to pay anything for co-pays, but this will be after about $5000 out of pocket for the year.

    What did the wise man say "buyer beware"?
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  • Dave,
    I have a policy that pays the portion Medicare doesn't. Costs me $370 per month, but without it I'd be sunk. It is Blue Cross plan F. At this point, I haven't had to pay for anything, except for meds. I purchased a rx plan for about $45 per month with United Healthcare. I have a co-pay with that.

    The premium is a killer, but it would be stupid for me not to have it. There are a lot of different companies out there, but this was the one I chose because I don't have any co-pays. It even pays the medicare deductible at the beginning of the year.
    Surviving chronic pain one day at a time, praying for a reprieve because living another 40 years like this doesn't sound too fun!
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    All I can say is YIKES !!!!!

    The fun just never ends, one step foward 3 steps back!!

  • both of our plans cost about the same, mine would be a little lower if I didn't have so many Rx's where I hit that wonderful $2000 donut hole where they don't cover.

    My wife takes almost no Rx's, so she doesn't carry a Rx policy. It's a lot cheaper, but if anything happens where she needs an expensive prescription, it's gonna be expensive. It's the chance you take I guess.

    My prescriptions cost over $1000 per month retail. I only pay $3 each until the donut hole. It works out that I have to pay cash for my drugs 2 months out of the year.

    And to think I used to love donut holes(the sugar coated ones)lol.
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  • I have Medicare Supp Insurance thru Anthem BC BS of Missouri (state I used to live in) got it 8 yrs ago;
    5 yrs ago; switch coverage plan to F - High Deductible my monthly premium has been as low as $45 with yearly deductible of $1,000 and is currently $52 with a $2,000 deductible.

    I was told by Missouri insurance experts to not change my policy once in another state, i.e. Florida rates quite different, not as good on coverage and much higher rates.

    Sorry, Dave, this may not make you feel any better, but thought you might want input anyway :)

  • Hi Dave,
    First off, many people get Medicare and Medicaid confused. When one is on SSD for 2 years, one is eligible for Medicare. Otherwise, Medicare starts when one turns 65.
    Medicaid is a federally funded program run by each state so the income and assets eligibility vary from state to state. Usually one has to have very low income and assets to qualify. For those that are on Medicare and don't qualify for Medicaid, a medigap plan or a Medicare Advantage plan can be a big help in covering the portion of medical expenses that Medicare doesn't cover or at least some of the expenses that Medicare doesn't cover. If you are under 65, you may have less selection in plans that are available in your state. One place to get advice on what is available in your state is your area office on aging. Ask for a SHIP counselor. (State Health Insurance Program) These individuals are trained to guide people through the Medicare maze and they could give you some ideas about what programs are available in your state.
    Regarding drug coverage for those on Medicare, finding the most cost effective prgram can be found by using the plan finder at medicare.gov. You enter all your meds and the computer program will list all the programs available in your area by total cost. A SHIP counselor can also help you in finding a drug program. A SHIP counselor can help evaluate your eligibility for other programs such as the Extra Help from Social Security in paying drug costs or assistance from drug manufacturers.
    A SHIP counselor does not sell insurance. They help people understand what is available and how programs work. They are trained and tested to maintain their certification as Medicare/Medicaid counselors. They are a great resource for people on Medicare or going on Medicare and their services are free.
    I know. I'm a SHIP counselor.
  • MetalneckMetalneck The Island of Misfit toysPosts: 1,778
    edited 06/26/2012 - 3:51 AM
    I chose a Blue Shield of Illinois plan F that covers both the inpatient and outpatient deductibles .... and will also cover any excess charges that non-participating Medicare (accepting assignment) docs might bill. No deductibles with the supplement and then picked up a Medicare part D plan through Blue Shield also.

    The supplement coverage is about $240 per month and the part D plan is $38.

    My SSD payment is greater than 133% of the federal poverty level so there is no Medicare part B premium help or public aid help with the co-pays on drugs or the donut hole. At least I have great coverage for everything else. Most of my meds are generic and are fairly low cost .... all 10+ of them so it might cost me a bunch of $3,00 co-pays but thats still better then 10 X $20 - $50.

    It also opens up a entire new bunch of meds that I can try, now that I am viewed as a real person with real insurance instead of just another patient on "public aid". (They had a very limited formulary).

    Medicare with a Blue Shield secondary!! I'm in insurance heaven!!

    Thanks for all the input and suggestions. My insurance broker and I are going out for a nice steak dinner this Thursday night!! First time I've been out to eat in over a year ++. I think he may even buy!!

    Nothing like a nice aged char-crusted filet mignon!!

    Oh and P.S. I'm moving out of my ex's spare bed room in her apartment into a great ground floor one bedroom that is two blocks from everything!! Grocery store, Big Park, Walgreens, Donut Shop, Pizza place, Attorneys office, train stop. etc. Its location location location - Moving on July 14th - back to independent living!! Yippie !!

    Regards to all,

  • Dave,
    You made a good choice getting Plan F. It is interesting to note that Plan F costs vary a lot depending on where you live. The Plan F that I have been looking at costs about $117 a month. ( I live in a small town, rural area.) Same coverage though.
    Re: your BCBS drug plan, or any drug plan as far as that: If your pharmacy offers generics at a lower price than your drug plan, you don't have to use your drug plan. A good pharmacist will work with you in getting the lowest cost on your meds. It is generally good to get in a drug plan so you don't get a penalty for non-coverage later on.
    Good job! Great coverage!
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